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April 2016
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  • ISMS to Lawmakers: Networks Must Be Adequate, Accessible and Transparent

    Over the last year ISMS has heard from many of our members who are concerned about health insurer network changes that have negatively affected the physician-patient relationship.

    Increasingly, commercial health insurers are "downsizing" patient options by establishing "narrow networks." These offerings save health plans money by imposing severe limitations on the number of health professionals available to patients. Illinoisans enrolled in narrow networks are travelling longer distances to see a doctor and may be unable to see a preferred physician.

    The impact of reduced network options is significant. Patients are confused and their care disrupted when abruptly forced to switch doctors. Many face significant sticker shock when billed for specialty care that was previously, but no longer, in-network.

    There is, however, good news to report. Illinois lawmakers recently introduced ISMS-backed legislation to take on the insurance companies and defend patients' rights.

    Introduced last week, House Bill 6562 would require health insurers to develop networks that meet the needs of patients for plans sold in Illinois. The bill further protects the continuity of care for pregnant mothers and patients with certain other conditions from being forced to transition away from a physician when network options change.

    Under the Network Adequacy and Transparency Act, insurers would also be required to maintain up-to-date directories of "in-network" health professionals and facilities, and communicate with patients when there are changes to the networks.

    ISMS is aggressively working to enact House Bill 6562, which addresses what has been a point of significant frustration for patients and doctors.

    For updates, stay tuned to the Legislative Action Hub and watch future editions of Physician Advocate.

    Learn What Physicians Had to Say about Potential Merger of Aetna, Humana




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